Spontaneous Clearance of Hepatitis C Virus in a Patient Co- Infected with Hepatitis C Virus and Human Immunodeciency Virus: a Case Report

Abstract

The effect of highly active antiretroviral therapy (HAART) on hepatitis C virus (HCV) infection remains unclear. Spontaneous HCV clearance with initiation of HAART in non-cirrhotic HCV patients co-infected with human immunodeficiency virus (HIV) has been reported. We describe an HIV/HCV patient with decompensated cirrhosis, who had spontaneous HCV clearance after an episode of elevated liver enzymes and a change in HAART regimen. His HCV RNA level remained undetectable for six months by quantitative and qualitative polymerase chain reaction (PCR) tests. The disappearance of HCV RNA may be due to a combination of host immune recovery, genetic polymorphism and direct effect of HAART against HCV.

Repeated Spontaneous Clearance of Hepatitis C Virus Infection in the Setting of Long-Term Non-Progression of HIV Infection

“…A number of factors may help predict spontaneous clearance, such as treatment-associated immune reconstitution and the presence of certain genetic polymorphisms (IL28B-CC and HLA-B57 among them). 9 , 14-16 In a Spanish study of HIV/HCV co-infected individuals, 75 HIV controllers, (including 33 LTNP and 42 elite controllers) were compared to 261 other subjects with a broad range of HIV plasma viral load measures above 1000 copies/mL. All HIV controllers, including elite controllers, had lower circulating HCV viral load measures, and the presence of the HLA-B57 allele was predictive of lower values across all groups.…”

Factors associated with spontaneous clearance of chronic hepatitis C virus infection

“…Case reports have also described clearance following the withdrawal of immunosuppressive medication [15], in the context of liver transplantation or surgery [16,17], following the development of hepatocellular carcinoma [18] and during pregnancy/parturition [19,20]. Additionally, spontaneous HCV RNA negativity has been described in HIV-HCV co-infected patients, including those with hepatic decompensation, following initiation or optimisation of antiretroviral therapy [21][22][23].…”

Spontaneous clearance of serum HCV-RNA after splenectomy in a patient with HCV-related liver cirrhosis and portal hypertension: a case report

“…Spontaneous clearance of chronic HCV is rare, with a reported incidence of 0.11 to 0.74 per 100 person-years [ 2 , 3 ]. Spontaneous disappearance of HCV-RNA is associated with pregnancy [ 15 ], alcoholic hepatitis [ 16 ], hepatocellular carcinoma [ 3 ], the IL28B genotype [ 17 ], human leukocyte antigen-B27 [ 18 ], superinfection with hepatitis B virus [ 19 ], HIV coinfection [ 7 ], and surgical stress [ 4 ]. A T-lymphocyte response is thought to be involved in HCV-RNA clearance, but its mechanisms are not well understood [ 3 , 5 , 6 , 15 ].…”

“…By contrast, spontaneous clearance of serum HCV in patients with chronic infection is rare, with an incidence rate of 0.11 to 0.74 per 100 person-years [ 2 , 3 ]. Spontaneous clearance of HCV-RNA has also been reported after total gastrectomy [ 4 ], use of minimal immunosuppressants and prednisolone in patients with HCV reinfection after liver transplantation [ 5 ], use of immune checkpoint inhibitors in the oncology setting [ 6 ], and initiation of highly active antiretroviral therapy for human immunodeficiency virus (HIV) coinfection [ 7 ]. A T-lymphocyte response is thought to be involved in HCV-RNA clearance [ 3 , 5 , 6 ].…”